Waterlase Training Seminars
TheThe Journey of Journey of
ExcellenceExcellence
Lasers will take you to the next level ofLasers will take you to the next level of
excellenceexcellence
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LASERTISSUE
INTERACTIONCold Cut vs. Thermal Cut
Thermal Relaxation
H mode vs. S mode
High vs. Low Hertz
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LASERTISSUE
INTERACTIONBiostimulation
Cold Cut vs. Thermal Cut
Thermal Relaxation
H mode vs. S mode
High vs. Low HertzCOPYRIGHTED M
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Photo-biological Effects of Lasers
Photo-chemical EffectsStimulate Chemical Reactions
Break Chemical Bonds
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Biostimulation
HeNe, & Other Lasers (650nm – 750nm)Pain Relief
Diode LASER (800nm – 950nm)Accelerated Wound Healing
Fibroblast Proliferation
Osteoblast Proliferation
Increased Synthesis of Collagen Growth
Enhanced Phagocytic Activity of Leukocytes
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Waterlase MD
Two Types of CutsCold cut
Energize water from the Laser
Thermal cut (Heat cut)Energize water in the tissue
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Cold Cut requiresHigher WattsHigher Water
Higher Air
Water does most of the cutting.Little laser absorption by the tissues
Cold Cut (Energized Water)Cold Cut (Energized Water)COPYRIG
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HARD TISSUE & FIBROTIC TISSUEGREATER DEPTH OF PENETRATION
Rapid cuttingWater does most of the cutting
Lased surface very irregularLittle laser absorption by the tissues
Cold Cut (Energized Water)Cold Cut (Energized Water)COPYRIG
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Thermal Cut (Energized Tissue)
Thermal Cut requires
Lower Watts
Little to No Water
Lower Air
The water in the tissue absorbs the laserbeam and is volatilized.
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Thermal Cut (Energized Tissue)
Soft Tissue cutting only
Little penetration of Tissues (30-40 microns)
Lased surface very smooth
Laser band-aidThe water in the tissue absorbs the laser
beam and is volatilized.
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THERMAL RELAXATION
The time that the laser energy isOFF is referred to as the thermalrelaxation time, the time duringwhich the target tissue is
allowed to cool.
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Don’t Judgethe
S settingto quickly!!!!!
I didI did
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Coagulation of the softtissue
•Long pulse (S mode, 10times longer)
•More pulses per second(50 Hz maximum)
(in both cases, water level
should be low)
T o
increase
Waterlase MDWaterlase MD
H mode vs. S modeH mode vs. S modeCOPYRIG
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Power = Energy x FrequencyCOPYRIG
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Power = Energy x FrequencyH Mode
HARD TISSUE CUTTING
HIGH ENERGY (H)
(COLD CUT)
LONG THERMAL RELAX.
10 to 15 Hz (no anesthesia)
20 to 25Hz (with anesthesia)
Greater Energy Penetration
High energy (200 - 300Mj)
2 - 4 Watts (10-15 HZ)
5 - 7 Watts (20-25Hz)
SOFT TISSUE CUTTING
(COLD & HEAT CUT)
SHORT THERMAL RELAX.
30 - 50 Hz
Topical Anesthesia
Less energy Penetration
Low energy (50 - 150Mj)
.50 - 2.25 Watts
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Power = Energy x FrequencySoft Tissue Cutting
H Mode (High Energy)
(Low Power &Short Pulse)
SOFT TISSUE INCISING AND
SURGERY
• High Frequency (pulses)
1. More penetration
2. Less Thermal than S
3. 30 to 50 Hz
• Lower Energy
1. Less than half
2. 100 to 200 mj
S MODE (LOW ENERGY)
(High Power & Long Pulse)
SOFT TISSUE BEVELING
AND CONTOURING
• High Frequency (pulses)
1. Minimal Penetration
2. Most Thermal
3. 30 to 50 Hz
• Higher Energy
1. Higher watts
2. 150 to 275 mjCOPYRIGHTED M
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H mode (Short pulse)vs.
S mode (Long pulse)COPYRIG
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LASER TIPSLASER TIPS
ANDAND
SETTINGSSETTINGS
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INCISING PROCEDURESCOLD Cut in H mode
Tips - Z6-6mm, Z4-9mm & G6 & C6-6mm
H mode / 10 - 15 Hz (no anesthesia)H mode / 20 - 25 Hz (with anesthesia)Watts 1.75 – 4.50Air 60%Water 30%
10 Hz @ 2Watts or 15 Hz @ 3.5 Watts
Hard TissueHard TissueCOPYRIG
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INCISING PROCEDURESCOLD Cut in H mode
Tips - T4-6mm, C6-9mm, & C3-9mmH mode / 20-40 HzWatts 1.25 – 2.50 (1.75)Air 20 - 30%Water 15 - 25%
40 T0 50 Hz more thermal & less penetration than 20 Hz
Soft Tissue CuttingSoft Tissue CuttingCOPYRIG
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INCISING PROCEDURESCOLD Cut in S mode
Tips - Z6 & Z4 - 9mmS mode / 15-50 HzWatts 1.25 – 2.50 (2.00)Air 20 - 30%Water 15 - 25%
40 T0 50 Hz more thermal (Slower cutting)
More penetration less thermal with 15 Hz (Faster Cutting)
Soft TissueSoft TissueCOPYRIG
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LASER BEVELINGCOLD Cut in S mode
Tips C12-9mm & Z6-9mmS mode / 30-50 HzWatts 2.00 - 2.75Air 15 - 20%Water 10 - 15%
30 Hz cuts faster, 50 Hz gives better hemostasis
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LASER Band-AidHeat Cut in H & S mode
Tips C12-9mm & Z6-9mmH&S mode / 40-50 HzWatts .50 - .75Air 20%Water 0
H mode 40 Hz deeper penetration
S mode 50 Hz best hemostasisCOPYRIGHTED M
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Z4Z4
Z6Z6
C6C6C3C3
H modeH mode
40 Hz40 Hz
25% Air 15% Water25% Air 15% WaterCOPYRIG
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tip comparisonsCOPYRIG
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COLD CUT
S 40HzS 40Hz
S 15HzS 15Hz
H 40 HzH 40 Hz
H 15 HzH 15 Hz
Z6 TipZ6 Tip
1.5 Watts1.5 Watts
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S ModeS ModeH ModeH Mode
15Hz 40Hz 50Hz 15Hz 40Hz 50Hz15Hz 40Hz 50Hz 15Hz 40Hz 50Hz
THERMAL CUTTHERMAL CUT
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Heat cut h s modeCOPYRIG
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Laser Band Aide
Z6 at .75 W15 Hz - H mode - High Thermal Damage
40 Hz - H mode - Low Thermal Damage
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BONE ABLATION
Bone Cutting (100mj)
Tip effect?
G6, C6, Z6, Z4
Hertz effect?
20 - 50 Hz
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BONE HERTZ
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BONE ABLATION
Bone Cutting (100mj)
(2W at 20HZ)
Tip effect?
G6, C6, Z6, Z4
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BONE ABLATION
Bone Cutting (100mj)
Tip effect
Z6
Hertz effect?20 Hz at 2 Watts = 100mj
30 Hz at 3Watts = 100mj
40 Hz at 4Watts = 100mj
50 HZ at 5 Watts = 100mjCOPYRIGHTED M
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Waterlase MDWaterlase MDFlap SurgeriesFlap Surgeries
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.
Effects of Erbium,Chromium:YSGG Laserirradiation on canine mandibular bone.
Kimura Y, Yu DG, Fujita A, Yamashita A, Murakami Y, Matsumoto K.
RESULTS: Regular holes or grooves having sharp edgesand smooth walls were produced, but no melting orcarbonization was observed.
CONCLUSION: These results showed that the Er,Cr:YSGGlaser cuts canine mandibular bone effectively withoutburning, melting, or altering the calcium: phosphorusratio of the irradiated bone.
J Periodontal. 2001 Sep;72(9):1178-82
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The Er: Yag (Er,Cr:YSGG) laser has a high
bactericidal potential at a low energy level. Er-Yag
laser removed 83% of lipopolysaccharides from root
surfaces.
Scanning electron microscopy revealed a
distinct rough surface structure in all samples
treated with Er: Yag laser irradiation. Scaled-only
samples yielded the smoothest surface, whereas
combined treatment (laser then scaling) resulted in a
variform pattern of rough and smooth areas. In all
samples, concrements were entirely removed.
H. Yamaguchi, K. Kobayashi, R. Osada, E. Sakuraba, T. Nomura, T. Arai, J. Nakamura. Effects of irradiation of an Er-Yag laser
on root surfaces. J Periodontol. 1997:68;1151-1155.
U. Schoop, A. Moritz, W. Kluger, et al. Changes in root surface morphology and fibroblast adherence after Er: Yag laser
irradiation. J Oral Laser Applications. 2002:2;83-93.
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The culturing of fibroblasts did not show
any significant differences regarding the number
and the density of the cells among the different
groups. However, significantly more spindle-
shaped cells were found on laser irradiated roots.
This indicates a better adherence of the cells to
those surfaces. The trend was better cell
adherence on lased plus scaled surfaces. Lased
root surfaces seem to provide an ideal foundation
for periodontal regeneration when compared to
scaled only surfaces.U. Schoop, A. Moritz, W. Kluger, et al. Changes in root surface morphology and fibroblast adherence after Er: Yag laser
irradiation. J Oral Laser Applications. 2002:2;83-93.
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•Biostimulation with a diode laser at 3J/cm2 can increase fibroblast
proliferation six-fold.
•Diode lasers have been utilized to close oral-antral openings through
Biostimulation.
•Irradiation with a pulsed diode laser has a biostimulating effect on
osteoblasts in vitro, which might be used in osseointegration of dental
implants.
•Low-intensity laser irradiation influences endothelial cell
proliferation and might thereby contribute to the increase in
angiogenesis and the acceleration of wound healing in vivo.Effect of low-power laser irradiation on cell growth and procollagen synthesis of cultured fibroblasts.
Pereira AN, Eduardo Cde P, Matson E, Marques MM. Lasers Surg Med. 2002:31;263-7.
Conservative closure of antro-oral communication stimulated with laser light.
Grzesiak-Janas G, Janas A. J Clin Laser Med Surg. 2001 Aug:19;181-4
Biostimulation of bone marrow cells with a diode soft laser.
Dortbudak O, Haas R, Mallath-Pokorny G. Clin Oral Implants Res. 2000 Dec:11;540-5
Direct stimulatory effect of low-intensity 670 nm laser irradiation on human endothelial cell proliferation.
Schindl A, Merwald H, Schindl L, Kaun C, Wojta J. Br J Dermatol. 2003:148; 334-6.
DIODE BIOSTIMULATIONCOPYRIG
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THE LASER IS AGREAT TOOL IN
TRAINED HANDS...
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Surgical ProceduresSurgical ProceduresCOPYRIG
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